Child and Adolescent Marijuana Use Has Implications for Pediatric Practice

By Will Boggs MD

July 15, 2020

NEW YORK (Reuters Health) - Pediatricians should understand the range of impacts child and adolescent marijuana use can have on their practice, according to a review.

An estimated 32% of white students, 42% of Hispanic students, and 43% of Black or African American students report ever having used marijuana, and the prevalence of current marijuana use ranges from 13% of 9th-graders to 26% of 12th-graders.

Dr. Jonathan D. Klein from University of Illinois at Chicago and colleagues summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice in their online review in Pediatrics.

The potency of cannabis, as measured by tetrahydrocannabinol (THC) content, has increased sixfold to sevenfold in recent years, but there is no standardized form of cannabis, and the presence and relative amount of various substances may differ between cannabis extracts.

THC acts as an agonist at endocannabinoid receptors CB1 and CB2, thereby producing not only analgesic and anti-inflammatory effects, but also impairments in learning, memory, spatial orientation, and attention.

Cannabidiol, on the other hand, has only weak affinity for CB1 receptors and does not interact directly with CB2 receptors and does not produce the intoxicating effects associated with THC.

Synthetic cannabinoids, such as the FDA-approved dronabinol and nabilone (for nausea) and the recreational drugs Spice and K2, are biochemically similar to THC. Use of the recreational drugs has been associated with severe adverse health effects, including cardiac abnormalities, coagulopathies, and neuropsychiatric abnormalities.

Cannabis and cannabinoids are effective for chronic pain in adults, for antiemesis in chemotherapy-induced nausea, and for improving spasticity in multiple sclerosis. Very few studies have addressed their use in children or adolescents.

Adverse effects associated with cannabis use include distorted perception, poor concentration, psychosis, excessive vomiting, and addiction.

Because of the paucity of research on maternal marijuana use, women should refrain from marijuana use during pregnancy and breastfeeding.

The authors stress the importance for providers to be aware of policies and laws around marijuana in their states to provide appropriate and evidenced-based recommendations and to counsel appropriately to prevent exposure and thus harm to developing brains.

"More research is needed on the long-term effects of marijuana and should also be focused on prevention of use in adolescence," the authors conclude.

Dr. George Sam Wang from University of Colorado Anschutz Medical Campus in Aurora, who has described the impact of marijuana legalization on pediatric exposures there, told Reuters Health by email, "As more states allow both medical and recreational marijuana, physicians and public health officials need to be aware of the 'unintended' negative physical and mental health consequences marijuana may have on the pediatric population. They also need to be aware of all the 'non-traditional' products that are now available and the potential health impacts."

"People should advocate for strict rules and regulations on marijuana products," he said. "This includes (but not limited to) regulations on mass marketing (especially those targeted at adolescents), packaging (child-resistant packaging), dose limitations, and regulations behind non-traditional products (edibles, concentrates). (We also need) educational prevention programs targeting youth, young adults, and other vulnerable populations (pregnancy), along with treatment programs and infrastructure to support and treat those with marijuana use disorder."

In a second report in Pediatrics, Amy E. Carver, PharmD from Children's Hospital Colorado, Aurora, and colleagues describe their hospital's policy for medical marijuana use, which includes a unique consultative service consisting of a clinical pharmacist and social worker.

Under this policy, hospitalized patients are allowed to use oral or topical forms of medical marijuana if they had obtained a medical marijuana registry identification card in compliance with Colorado state law, but team members are not allowed to prescribe, order, administer, or handle medical marijuana products.

The consultation service, which is provided without charge to the family, was created to support patients, families, and their primary clinical care teams in the provision of education, encouragement of open communication, and promotion of the safe use of medical marijuana and other cannabinoids products.

The team consulted 50 patients between March 2017 and June 2019. But there were 337 medical marijuana use acknowledgments during that period, suggesting that inpatient programs are largely accustomed to the use of medical marijuana products by pediatric patients and are requesting additional consultative support in the minority of cases.

Most consult patients had an oncologic diagnosis, and the most common reasons for medical marijuana use or potential use were nausea and vomiting (40%), appetite stimulation (36%), and pain (38%).

Most patients (62%) were not using a medical marijuana product at the time of the consultation. Instead, families had questions about the safety of medical marijuana use or wanted to obtain more information before deciding if medical marijuana was right for their child.

Dr. Carver told Reuters Health by email, "It's important to recognize that medical marijuana products are life-changing for some patients. It's also important for families to feel comfortable being transparent about marijuana use."

"Allowing these patients to continue use while admitted to the hospital without judgment is, in many cases, the right thing to do, and having a consult team of experts available in the hospital setting provides the opportunity to evaluate the safety of medical marijuana use and provide education if needed," she said.

Dr. Klein did not respond to a request for comments.

SOURCE: https://bit.ly/3exbQw1 and https://bit.ly/2AYddpG Pediatrics, online July 13, 2020.

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